Hi Dr. Hall,
I had a root canal done on my front tooth over 10 years ago. In the past few years I had noticed a blue discoloration at the top of the tooth. After trying internal bleaching, my dentist ended up doing a crown.

The first crown that came back from the lab looked very white. He redid it. The next tooth, which is in my mouth now, looks better but doesn’t match the other front tooth. The dentist permanently cemented it in, but when I got home and took some selfies I was unhappy with how unnaturally white it looks.

The dentist will give it another try but my question is — should I let him try again or go to someone else who specializes in cosmetic dentistry? I now live in Princeton, NJ and my dentist is in Brooklyn. Cost is a factor.
Thanks,
Ronnie

Ronnie,
Doing a crown on a single front tooth is a tricky procedure. The slightest variation in color between the two front teeth is usually very noticeable. And it isn’t just the overall color—any tooth has multiple colors in it. Even expert cosmetic dentists will often have multiple try-ins before they get the crown to match perfectly. When I was in practice, I charged about 40% more for crowning a single front tooth because we would typically send it back to the lab three or four times until we got it perfect and I would charge the extra fee because of all the extra appointments. Dentists with poor cosmetic dentistry skills sometimes ask patients to crown both front teeth in order to get the color right.

That your dentist would think that the crown would look right after one or two trips to the lab shows either inexperience or a low level of commitment to excellent cosmetic dentistry. I’m not meaning to imply condemnation with that comment because that is typical of the overwhelming majority of dentists—maybe 98% of them. So yes, if you want this done so that your two front teeth match perfectly, you need to raise your sights and go to an excellent cosmetic dentist such as we recommend. There are several excellent ones within reasonable driving distance of Princeton, say 15-30 miles.

However, depending on how big a factor cost is for you, and if your dentist is willing to work with you to get this right for no extra charge, you may want to stick with this dentist to save the money of having another dentist start over with you. And, I would add, if you are willing to make several more trips back to Brooklyn. To help the process, you or the dentist should get hold of a good digital camera that is capable of taking a clear photograph of the new crown in place next to your natural tooth under outside light, such as right next to a window. That will go a long way toward helping the ceramist pin down the right color. And be sure that the crown is only temporarily cemented until you have seen it under various lighting conditions.

If you want perfection—a crown so natural that you can’t distinguish it from the real tooth next to it—you need the expert cosmetic dentist. But if you are willing to accept some compromise of that ideal in order to save money—try letting your dentist have some more tries to get this closer.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

Hello Dr. Hall,
Back in May 21st I had my front upper tooth knocked out. It was put back in, bonded and set back into place. I had a root canal done on it as well. I’m noting that the color is slightly off (more yellow) than the rest of my teeth. My dentist said that I would probably have to get a crown after my last visit, but looking online I see that a crown for a front tooth may not be a good idea. How can I preserve the whiteness of this tooth without needing a crown? Thank you for your time.
– Joseph from Staten Island, NY

Joseph,
You’re right. A crown on a front tooth, while it strengthens it against chipping, actually weakens the tooth against lateral stresses. So if you have a heavy bite at all, it is at greater risk of breaking off.

After a root canal treatment, a tooth tends to discolor. But that discoloration can be greatly lessened by cleaning out the inside of the crown from any root canal filling materials such as gutta percha or cement. If it is starting to discolor already (four months after treatment), the dentist has left some of those materials inside the visible part of the tooth.

Here’s what I would do.

Go to one of our recommended cosmetic dentists in Manhattan, Queens, or New Jersey, and have them clean out the inside of the crown. Since the tooth has begun to discolor already, it would be a good idea to have them do internal bleaching. Then you could have them fit the tooth with a fiberglass post inside and seal the opening, and you should be good for several years before it starts to discolor.

Then, when it discolors, I would just have them do a single porcelain veneer to correct that. This would require a fair amount of expertise in appearance-related dentistry to match the color of the adjacent tooth, but I’m confident that any dentist we list would be able to get that to look great for you.

Oh, one other thing. Since this is a replanted front tooth, you want to have it x-rayed again to make sure you don’t have any external resorption. It’s possible that your body could be eating away at the root. That happens sometimes with these replanted teeth. Be sure to find that out before you invest much money into this tooth.

And just a comment about your dentist. It looks like he or she did a nice job of saving your tooth—did all the right things, and is probably an excellent dentist. But these demanding aesthetic problems are over the head of the vast majority of general dentists.

I hope this is helpful.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

I had a left central incisor that underwent root canal treatment in 2004. It subsequently turned grey and I underwent internal bleaching last year.

The tooth still looks grey under certain lighting conditions and does not match my right central incisor. I am hesitant to get a porcelain veneer or crown as I would like to be as conservative with tooth structure as possible.

Also, I am aware of people who have problems with their porcelain veneers/crowns – poor colour matching, cracks, dislodgement, that result in repeated adjustments and more damage to the enamel each time.

Hence, I am considering composite veneers on either one or both central incisors to match them – if I need to change the composite veneers due to staining 5-7 years later, will I end up grinding off more enamel each time the composite veneer is changed? Is it possible to only drill off part of the old composite and bond a new composite veneer on the old composite itself(i.e. composite-composite bond)? If a composite-composite bond is feasible, then I could replace the veneers as required without harming any more natural tooth structure each time.

As composite veneers only last 5-7 years, I am worried that repeated replacements will eventually damage all my remaining enamel if more enamel has to be drilled each time (I am in my late 20s).

Please kindly advise if composite veneers would be a feasible long-term solution. I do not mind repeated costs, or having to visit the dentist every few months for touch up. My main concern is being conservative to the enamel, and finding a sustainable solution in the long run.

Also, will well-maintained and well done composite veneers look natural and blend well with the rest of my teeth?

Thank you Dr. Hall
– James, from an undisclosed location

James,
You’re not going to have to worry about possible damage from having this work re-done repeatedly if you get it done right. But if you don’t have it done right, yes, I have seen a minor correction to make two front teeth match escalate into two full crowns for the front teeth, where each tooth gets whittled down to a stub.

The key is going to be getting the right dentist. It is a small minority of dentists who will be able to get your tooth matched. And it is a slightly smaller minority who will do that in an ultra-conservative way, which sounds like what you want. But even if the dentist isn’t ultra-conservative, as long as it is done right you shouldn’t have to worry about repeated assaults on your tooth.

So your situation is one slightly discolored front tooth, and you’re apparently happy with the rest of your smile. The way I liked to treat cases like this was with direct dental bonding. I would shave off some of the front surface of the tooth to make room for the bonding material and so that the result would be no thicker than the companion front tooth. And then, with a combination of opaquers, tints, and composites of varying shades and translucencies, I would build up the discolored tooth to match its companion. I preferred using composite to doing a porcelain veneer because I could monkey with the color right there and get a perfect match without trips back and forth to the lab and having to communicate what I was seeing to the lab technician.

The same result could be accomplished with a single porcelain veneer. Some dentists will be very aggressive in their tooth preparation for a porcelain veneer and will grind away a lot of the tooth. But most expert cosmetic dentists will be pretty conservative, removing only a fraction of a millimeter of tooth structure. I would think that would meet your requirements of conservatism. And with a porcelain veneer, if the cosmetic dentist has done a lot of these, he or she will want to charge a premium fee, as I did, because there are going to be many trips this veneer will make back and forth to the lab with multiple try-ins to get the color perfect.

Lifespan of dental bonding

As far as the lifespan of the work, I will explain why I don’t think that should be a problem. With the bonding, it is the surface that deteriorates after maybe 3-5 years (longer if you use a gentle toothpaste like Supersmile), and the maintenance would simply be re-surfacing the composite. It wouldn’t have to be totally ground off and start over. With the porcelain veneer, if it is done right it could last many years. There isn’t a fixed lifespan there. If you take good care of it so that you don’t get decay on the edges or fracture it, it could possibly last twenty years. It’s not like a tire that wears out, but more like a piece of fine furniture that could fall prey to abuse, but if it is well cared-for could last indefinitely. And then a good cosmetic dentist would have tools to be able to remove the porcelain and bonding composite without significantly affecting the tooth.

If you get a dentist who wants to treat both your front teeth so as to guarantee a perfect match, take that as a red flag. The dentist doesn’t have confidence in his or her color skills to be able to match the adjacent tooth.

If you do want to share your location, I could help you further by possibly steering you to a cosmetic dentist who would be up to this task.
– Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.